ROLES OF NURSES IN DISASTER AND EMERGENCY SITUATION A disaster is a cataclysmic incident that commonly leads to immense damage and

devastation. Whether the cause of the event is natural, or man-made, the outcomes can be shocking. These disasters often overwhelm the local first responders, health organizations, and government operations. Preparedness is one of the major components of disaster response. A nurse may play several roles during a disaster. Preserving Open Lines of Communication

Communication allows staff to gather the information necessary to perform well. Communication difficulties are normal during disasters. Loss of e ectrical power and overcrowding may cause telephonedependent systems to fail. Messages not heard can cause confusion and panic. The nurse as manager has to consider how to internally and externally implement and distribute accurate information to the proper individuals. Further, he must ensure constant communication with Department of Health medical director, head nurse, incident command center and Centers for Disease Control contacts. Ensuring Quality Patient Care

In times of disaster, confusion reigns and people need to work together as a team to achieve the same objective. The nurse as manager coordinates departmental efforts such as patient flow and bed counts. He interacts with the system to ensure the provision of quality care to disaster victims. This includes tracking patients carefully in the organization so that relatives and friends can be apprised of their condition and location. Providing Current Education

All nursing staff members should be aware of their role in the disaster plan and receive adequate training. In some cases, only those nurses in the organization perceived as critical care or emergency experts are trained. All medical and allied staff should receive instruction as first responders because in the case of large-scale destruction, there will be an increased need for the services of all types of employees. Further, nurses are often in a position to teach not only staff, but also the community about disaster preparedness. Influencing Policy and Financial Decisions

Disaster preparedness costs money. Nurses as managers have a part in determining costs, managing allocation, and advocating for expenses within a policy framework. Ways to influence the distribution of monies include participating in the state hospital associations and testifying before state legislatures so that policy makers are clear about the impact of decisions. Providing Security for Staff, Patients, and Families

In any given disaster situation the nurse as manager has to evaluate security issues for self, victims, and the first responder team. She needs to create entrance and exit standards for staff, patients, and visitors and implement lock-down procedures. She also should insure the security department is ready to maintain crowd and traffic control and avoid unauthorized access to the facility. Any disaster preparedness plan should include standards for dealing with the media.

INTRAVENOUS PARENTERAL THERAPY Definition: Intravenous (IV) therapy is the insertion of needle or catheter / cannula into a vein, based on the physicians written prescription. The needle or catheter/cannula is attached to sterile tubing and a fluid container to provide medication and fluids. Intravenous (I.V.) therapy and injection (intramuscular, subcutaneous) of vitamins, minerals and homeopathics is a safe and effective way to deliver nutrients in a timely and efficient manner. Par-enteral means substances given by this route are directly absorbed into the circulatory system, by-passing the enteric system or gastro-intestinal tract and liver, thereby increasing the absorptive capability of the individual. Standard and competencies of IV therapy Standard Operating Policies and Procedure are established to ensure safe IV therapy practice, to protect the patients by maximizing benefits and minimizing risks associated with IV therapy and to protect the practice of registered professional IV therapy nurses. The IV therapy policies and procedures are written and continuously updated and reviewed as necessary. 1. Key points prior to initiation of IV therapy a. Physicians prescribed treatment. The initiation of intravenous therapy is upon the written prescription of a licensed physician which is checked for the following: > Patients Name > Type and amount of solution > The flow rate > The type, dose and frequency of medication to be incorporated/pushed. > Others affecting the procedure (x-rays, treatment to the extremities, etc) b. Patient Assessment Factors to consider for IV therapy > Clinical status of patient > Patients diagnosis > Patients age > Dominant arm ( non) > Condition of vein/ skin

> Cannula size > Type of solution > Duration of therapy c. IV set and equipment preparation > Check for expiration date > Check for clarity; any presence of holes on plastic cover (packaging); plastic container (bag) for presence of sediments or insects. > Check label against the physicians written prescription > Label for any medication that are added: date, time, dose of medication and amount; compatibility of drug with the solution. > Functionality of infusion pump, patient controlled analgesia (PCA) d. Medications Nurses administering IV therapy should have knowledge on all medications administered including dosages, drug interaction and possible clinical effects on the vascular system. 10 GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY 1. Administer the right drug. 2. Administer the right drug to the right patient. 3. Administer the right dose. 4. Administer the right drug by the right route. 5. Administer the right drug at the time .6.Document each drug you administer. 7. Teach your patient about the drug he is receiving. 8. Take a complete patient drug history. 9. Find out if patient has drug allergies. 10. Be aware of potential drug drug or drug-food interactions.

2. Competency a .Hand washing

b. Assessing of vital signs c. Standard precautions d. Principles of aseptic technique e. Medication calculation f. Medication administration CANNULATION PROCEDURE Position the patient comfortably. It may be helpful to support his or her arm on a pillow. Wash hands and apply non-sterile gloves (Centers for Disease Control and Prevention(CDC) 2002). Apply a tourniquet to the upper limb to improve venous filling. This should not obstruct arterial blood flow and the radial pulse should still be palpable. Ask the patient to open and close the fist to promote venous filling. Clean the skin with a chlorhexidine-based solution and allow drying. Do not re-palpate the skin. Open the cannula carefully and ensure the stylet within the cannula is positioned with the bevel uppermost. Hold the patients arm or hand and use your thumb to pull the skin taut below the intended puncture site. This will stabilize and anchor the vein before cannulation. Hold the cannula in line with the vein at a 10-30 angle to the skin and insert the cannula through the skin. As the cannula enters the vein blood will be seen in the flashback chamber. Lower the cannula slightly to ensure it enters the lumen of the vein and does not puncture the posterior wall of the vessel. Withdraw the stylet slightly and blood should be seen to enter the cannula: this confirms the position in the vein. The stylet must not be re-inserted as this can damage the cannula, resulting in catheter embolus. Slowly advance the cannula into the vein, ensuring the vein remains anchored throughout the procedure. Release the tourniquet. Dispose of the stylet in the sharps container at the bedside. Flush the cannula to check patency and to ensure easy administration without pain, resistance or localized swelling. Secure the cannula with a moisture-permeable transparent dressing (Royal College of Nursing (RCN) 2003. The dressing should allow viewing of the entry site while firmly stabilizing the cannula to prevent mechanical phlebitis or cannula dislodgement.

 Record the cannulation procedure in the patients notes, including device, gauge, location, nurses signature and number of insertion attempts. Types of therapy 1. Maintenance therapy -Provides water, electrolytes, glucose, vitamins, and in some instances protein tomeet daily requirements. 2. Restoration of deficit -Solution addition to maintenance therapy, fluid and electrolytes are added to replace previous losses. 3. Replacement therapy -Infusions to replace current losses in fluid and electrolytes. INTRAVENOUS THERAPY COMPLICATIONS LOCAL COMPLICATIONS a. Infiltration b. Extravasation c. Thrombosis d. Thrombophlebitis e. Phlebitis

SYSTEMIC COMPLICATIONS a. Embolism b. Pulmonary embolism c. Air embolism d. Catheter embolism e. Hematoma f. Systemic infection g. Circulatory overload

NATURAL DISASTERS A natural disaster is a major adverse event resulting from natural processes of or effecting the Earth, for example floods, tsunami, tornadoes, hurricanes and cyclones, volcanic eruptions,earthquakes, heatwaves and droughts, wild fires, landslides, blizzards, ice storms and avalanches. A natural disaster can include loss of life, injury, economic loss, and environmental loss. The severity of the losses depends on the ability of the affected population to resist the hazard, also called their resilience. This understanding is concentrated in the formulation: "disasters occur when hazards meet vulnerability. Earthquake AKA tremor or temblor, is the result of a sudden release of energy in the Earth's crust that creates seismic waves. Earthquakes are recorded with a seismometer, also known as a seismograph. The moment magnitude of an earthquake is conventionally reported, or the related and mostly obsolete Richter magnitude, with magnitude 3 or lower earthquakes being mostly imperceptible and magnitude 7 causing serious damage over large areas. Intensity of shaking is measured on the modified Mercalli scale. At the Earth's surface, earthquakes manifest themselves by shaking and sometimes displacing the ground. When a large earthquake epicenter is located offshore, the seabed sometimes suffers sufficient displacement to cause a tsunami. The shaking in earthquakes can also trigger landslides and occasionally volcanic activity. In its most generic sense, the word earthquake is used to describe any seismic eventwhether a natural phenomenon or an event caused by humansthat generates seismic waves. Earthquakes are caused mostly by rupture of geological faults, but also by volcanic activity, landslides, mine blasts, and nuclear experiments. An earthquake's point of initial rupture is called its focus or hypocenter. The term epicenter refers to the point at ground level directly above this. Earthquakes and volcanic activity Earthquakes also often occur in volcanic regions and are caused there, both by tectonic faults and by the movement of magma in volcanoes. Such earthquakes can serve as an early warning of volcanic eruptions, like during the Mount St. Helens eruption of 1980. Aftershocks Main article: Aftershock An aftershock is an earthquake that occurs after a previous earthquake, the mainshock. An aftershock is in the same region of the main shock but always of a smaller magnitude. If an aftershock is larger than the main shock, the aftershock is redesignated as the main shock and the original main shock is redesignated as a foreshock. Aftershocks are formed as the crust around the displaced fault plane adjusts to the effects of the main shock. Landslides and avalanches Main article: Landslide

Landslides are a major geologic hazard because they can happen at any place in the world, much like earthquakes. Severe storms, earthquakes, volcanic activity, coastal wave attack, and wildfires can all produce slope instability. Landslide danger may be possible even though emergency personnel are attempting rescue. Fires Fires of the 1906 San Francisco earthquakeFollowing an earthquake, fires can be generated by break of the electrical power or gas lines. In the event of water mains rupturing and a loss of pressure, it may also become difficult to stop the spread of a fire once it has started. For example, the deaths in the 1906 San Francisco earthquake were caused more by the fires than by the earthquake itself. Soil liquefaction Soil liquefaction occurs when, because of the shaking, water-saturated granular material (such as sand) temporarily loses its strength and transforms from a solid to a liquid. Soil liquefaction may cause rigid structures, as buildings or bridges, to tilt or sink into the liquefied deposits. This can be a devastating effect of earthquakes. For example, in the 1964 Alaska earthquake, many buildings were sunk into the ground by soil liquefaction, eventually collapsing upon themselves. Tsunami The tsunami of the 2004 Indian Ocean earthquakeMain article: Tsunami Tsunamis are long-wavelength, long-period sea waves produced by an sudden or abrupt movement of large volumes of water. In the open ocean, the distance between wave crests can surpass 100 kilometers, and the wave periods can vary from five minutes to one hour. Such tsunamis travel 600-800 kilometers per hour, depending on water depth. Large waves produced by an earthquake or a submarine landslide can overrun nearby coastal areas in a matter of minutes. Tsunamis can also travel thousands of kilometers across open ocean and wreak destruction on far shores hours after the earthquake that generated them

Group 4
SUBMITTED BY:
AUDREY FRONDA SANTA ANGELICA BUGAYONG JANINE GERRARDO ROSE ANN AGCANAS APRIL BINCANG JOSEPH GARCIA JEFFORDSON LOPEZ

SUBMITTED TO: Jan Michael S. Valdez,RN